Supporting Older, Frail, and Vulnerable Adult Prisoners Through Peer Care: Observations, Reflections, and Recommendations Based on a UK/U.S. Researcher Exchange Visit.

This article describes key findings from a UK/U.S. prison health researcher exchange in September 2023. The aims were to increase familiarity with the research context and to observe the roles of peer caregivers in U.S. prison settings. The researchers identified several differences and similarities in peer caregiving between UK and U.S. sites and detail six recommendations related to policy and practice concerning both sides of the Atlantic. It is believed that the adoption of such recommendations will contribute to improved care and, thereby, the health and well-being of vulnerable people incarcerated in prison.

Safety Goggles with Elastic Headband to Improve N95 Fit Following Failed Quantitative Fit Test.

Introduction: N95 respirators, together with eye protection, form vital elements of personal protective equipment (PPE) for healthcare workers (HCW) caring for patients with respiratory infections, such as COVID-19. Duckbill N95 respirators are widely used but have a high failure rate when Fit Tested. The commonest site for inward leaks is the region between the nose and maxilla. Safety goggles with an elastic headband may press the upper rim of the respirator against the face, thereby reducing inward leaks. We hypothesized that the use of safety goggles with an elastic headband will improve the overall fit-factor of a duckbill N95 respirator and increase the proportion of users who pass a quantitative Fit Test. Methods: About 60 volunteer HCWs, who had previously failed quantitative Fit Testing with a duckbill N95 respirator, participated in this before-and-after intervention study. A PortaCount® 8048 was used for quantitative Fit Testing. The test was first performed with a duckbill N95 respirator only. It was then repeated after participants donned a pair of safety goggles (3M Fahrenheit, ID 70071531621). Results: Before the intervention, i.e., with the respirator only, 8 (13.3%) participants passed their Fit Test. This increased to 49 (81.7%) after the application of safety goggles (OR 42, 95% CI 7.14-1697.9, p < 0.0001). The adjusted mean overall fit factor, using Tobit regression analysis, increased from 40.3 to 193.0 (t = 12.32, p < 0.001). Conclusion: The use of safety goggles with an elastic headband significantly increases the proportion of users who pass a quantitative Fit Test and improves the fit-factor of a duckbill N95 respirator. How to cite this article: Kamal M, Bhatti M, Stewart WC, Johns M, Collins D, Shehabi Y, et al. Safety Goggles with Elastic Headband to Improve N95 Fit Following Failed Quantitative Fit Test. Indian J Crit Care Med 2023;27(6):386-391.

Promoting resilience among older people in prisons: a systematic literature review.

The number of older people in UK prisons has increased significantly in recent years and most of them have at least one health condition. Research has shown that the physical and mental health of older people living in the community is positively correlated with resilience, but there is limited research on how to promote resilience in older prisoners. This systematic literature review offers a synthesis of interventions, practices and processes that may improve resilience in older prisoners. The review included eight peer-reviewed studies and identified three elements that support resilience in older prisoners: organised interventions; relational activities; and subjective processes. Healthcare professionals working in prisons can use the findings to identify how to support older prisoners' well-being and develop the conditions that may enable older prisoners to sustain and strengthen their resilience.

Prediction of N95 Respirator Fit from Fogging of Eyeglasses: A Pilot Study.

AIM AND OBJECTIVE: Fogging of eyeglasses while wearing N95 respirators is common. It is commonly held that the N95 respirator has a poor fit if there is fogging of eyeglasses. We conducted this prospective, pilot study to determine if fogging of eyeglasses predicts poor fit of N95 respirator. MATERIALS AND METHODS: Seventy volunteer healthcare workers from a tertiary intensive care unit in Sydney, Australia participated. The participants donned one of the following N95 respirators: three-panel flat-fold respirator (3M 1870), cup-shaped respirator (3M 1860), or a duckbill respirator. After a satisfactory "user seal check" as recommended by the manufacturer, the participants donned eyeglasses and checked for fogging. A quantitative fit test (QnFT) of the respirator was then performed (using PortaCount Respirator Fit Tester 8048, TSI Inc., Minnesota, USA). A fit factor of <100 on quantitative fit testing indicates poor fit. The sensitivity and specificity for fogging of eyeglasses (index test) to predict the poor fit of N95 respirator was determined, compared to QnFT (gold standard test). RESULTS: Fogging of eyeglasses as a predictor of poor respirator fit (i.e., fit factor <100 on QnFT) had sensitivity of 71% (95% CI, 54-85%) and specificity 46% (95% CI, 29-63%). The odds ratio of fogging as a predictor for poor fit was 2.10 (95% CI, 0.78-5.67), with a two-tailed p-value of 0.22 (not significant). The receiver operating characteristic curve for fogging of eyeglasses as a diagnostic test had the area under the curve of 0.59. CONCLUSION: Fogging of eyeglasses is neither a sensitive nor a specific predictor for poor fit of N95 respirators. HOW TO CITE THIS ARTICLE: Kyaw S, Johns M, Lim R, Stewart WC, Rojas N, Thambiraj SR, et al. Prediction of N95 Respirator Fit from Fogging of Eyeglasses: A Pilot Study. Indian J Crit Care Med 2021;25(9):976-980.

Fit Factor Change on Quantitative Fit Testing of Duckbill N95 Respirators with the Use of Safety Goggles.

N95 respirators and safety goggles are important components of personal protective equipment to reduce the spread of airborne infections, such as COVID-19, among healthcare workers. Poor N95 respirator seal may reduce its protective effect, thereby increasing transmission. Quantitative fit testing is an established way of assessing the N95 respirator fit, which provides a quantitative measure for seal, called the fit factor. Duckbill N95 respirators frequently fail the fit test. We hypothesized that using safety goggles with a wraparound elastic headband will increase their fit-factor by reinforcing the seal between the face and the upper margin of the respirator. We studied the effect of safety goggles with a wraparound elastic headband (3M™ Chemical Splash Resistant Goggles, ID 70006982741) on the fit factor of two types of Duckbill N95 respirators (Halyard FLUIDSHIELD*3, Model 99SA070M, and ProShield® N95 Model TN01-11) in 63 healthy volunteers in a nonrandomized, before-and-after intervention study design. The mean fit factor increased from 69.4 to 169.1 increased from 17/63 (27%) to 46/63 (73%) after the intervention (p <0.0001, OR 3 [95% CI = 4.9-1223]). This is the first study to explore the impact of safety goggles on N95 respirator fit. We conclude that the use of safety goggles with a wraparound elastic headband increases the fit factor of the tested Duckbill N95 respirators. HOW TO CITE THIS ARTICLE: Johns M, Kyaw S, Lim R, Stewart WC, Thambiraj SR, Shehabi Y, et al. Fit Factor Change on Quantitative Fit Testing of Duckbill N95 Respirators with the Use of Safety Goggles. Indian J Crit Care Med 2021;25(9):981-986.

Reflections on the Performance of Emotion, Masculinity, and Position Within a Prison Ethnography.

In this article, a selection of emotionally charged situations encountered while conducting an ethnographic research project in a prison in the United Kingdom are outlined and analyzed. With reference to three impressionistic field notes, the researcher's responses to interpersonal challenges, and subsequent attempts at impression management, particularly in relation to maintaining a broadly "neutral" and "credible" status are described. The challenges were experienced in the context of the researcher's position within the hierarchical and gendered nature of prison culture; it is argued that the subsequent subjective feelings of ambivalence are characteristic of the relational uncertainties found within prison settings. Reflecting on the impact of emotionally loaded interpersonal encounters helps to support and enrich the quality of the analysis and research. Furthermore, the learning from this process may help researchers undertaking fieldwork in other closed institutions with similar features and with other vulnerable populations.

What Does the Implementation of Peer Care Training in a U.K. Prison Reveal About Prisoner Engagement in Peer Caregiving?

The number of aging and chronically ill prisoners continues to rise within the United Kingdom prison demography; consequentially, many institutions face health and social care crises of immense proportions. The needs of this group are both complex and costly, and in the United Kingdom, this is set to a backdrop of overcrowding, increasing violence, and public spending cuts in line with government austerity targets. In this context, the development of prisoner peer caregiving is proposed as an approach to mitigating the effects of aging, disability, and illness. A qualitative study was implemented to design, deliver, and evaluate a peer care training intervention within a U.K. prison. The perceptions of six prisoner peer caregivers are represented in this article. Thematic analysis of interview transcripts identified challenges experienced by peer caregivers in practice as well as recommended practical solutions. The social processes underpinning prisoner peer caregiving are discussed, including individual and organizational impediments to the fulfillment of their role. Practice theory, social learning theory, and criminological sensitivities were used as theoretical lenses to analyze the findings.

Peer social support training in UK prisons.

AIM: To undertake a service evaluation to assess the effect of peer social support training using two separate learning programmes, which were designed to assist prisoners to support older prisoners and prisoners with disabilities. METHOD: The service evaluation used an action research approach to support planning, delivery and data collection. Eleven interviews with nine prisoners who had undertaken the peer social support training programmes and two members of prison staff (one nurse manager and one prison officer) were recorded and transcribed by the researchers. This data was coded and thematically analysed to evaluate the findings. Recommendations were made regarding the format and content of the training. FINDINGS: The training was well received by the peer social support worker trainees and had several positive outcomes, including increased peer social support, improved relationships between peer social support workers and older prisoners and prisoners with disabilities, increased self-esteem, measured as 'social capital', among peer social support workers, and effective teamworking. CONCLUSION: The peer social support training programmes were considered to be a positive intervention and were effective in supporting peer social support roles. Recommendations for future training of prisoner peer support workers include involving existing peer social support workers in training and recruitment, and enhancing the role of peer social support workers in prisons by providing them with job descriptions.

Preventing, Identifying, and Treating Prescription Drug Misuse Among Active-Duty Service Members.

Prescription drug misuse (PDM) is of critical concern for the military because of its potential impact on military readiness, the health and well-being of military personnel, and associated health care costs. The purpose of this study is to summarize insights gleaned from a series of activities that the RAND Corporation undertook for the Deputy Assistant Secretary of Defense for Readiness to address this important health and military readiness issue. The authors completed a review of U.S. Department of Defense policies and a comprehensive literature review of clinical guidelines and the empirical literature on the prevention and treatment of PDM and conducted individual face-to-face interviews with 66 health and behavioral health care providers at nine medical treatment facilities across three regions within the contiguous United States to identify best practices in the prevention, identification, and treatment of PDM and the extent to which those practices are known and followed. The study also presents the framework of an analytic tool that, once informed by data available to the military but not available to the authors, can assist the military in predicting future trends in PDM based on current demographics of active-duty service members and rates of injury and prescribing of prescription drugs. The findings from this work led the authors to formulate a set of key insights that they believe might improve the rapid identification and treatment of service members dealing with PDM, thereby improving future force readiness.

Prisoner peer caregiving: a literature review.

Aim To explore the role of prisoner caregivers in providing peer social care to older prisoners and to identify methodological information and challenges to conducting research in prisons, to inform future research in this setting. Method The literature review was conducted in two stages. In the first stage, a systematic literature review was undertaken to retrieve articles related to prisoner caregiving. The main themes from these articles were identified. In the second stage, a narrative literature review was undertaken to provide contextual and methodological information about research, which may support future research in prisons. Findings The main themes identified in the systematic literature review were: the benefits of prisoner caregiving; training needs; and the organisational implications of implementing prisoner caregiving. The narrative literature review identified a range of methodological approaches used to undertake research in prisons. Challenges to undertaking research in prisons included practical issues, the influence of power on relationships and the difficulty for researchers not to take the side of either the prisoners or prison staff. Conclusion The role of prisoner caregiver is increasingly recognised as important, and is associated with several benefits to individual prisoners and the prison community. However, further training is required for prisoner caregivers, and there is a need for further research into the prisoner caregiving role, using a methodology that is suitable for the prison setting.

A Systematic Review of the Prevention and Treatment of Prescription Drug Misuse.

OBJECTIVES: This is a review and evaluation of the current clinical guidelines and empirical literature in relation to the Department of Defense (DoD) policies and directives regarding prescription drug misuse (PDM). METHODS: Sources were 11 clinical guidelines and consensus statements, 20 DoD Directives and the published literature from 2000 to 2012. Articles were included if they specifically focused on the prevention or treatment of PDM. RESULTS: DoD directives were evaluated in relation to the clinical guidelines and the relevant research literature. Empirical evidence supporting the directives was limited. CONCLUSIONS: There is little empirical evidence for the prevention and treatment of PDM and the majority of published guidelines and studies focus on prescription opioids. Important limitations include the lack of information about appropriately identifying and managing persons at risk for PDM. More research is needed to identify and recommend effective mechanisms for the prevention and treatment of PDM.

Reducing burnout in nurses and care workers in secure settings.

AIM: To identify which educational interventions reduce burnout and promote wellbeing in nurses and care workers in secure settings. METHOD: A systematic review of health, educational and criminal justice literature was undertaken to appraise relevant studies and identify educational interventions that were effective in reducing burnout. FINDINGS: There is some evidence that clinical supervision and psychological intervention training are successful in reducing burnout in nurses and care workers in secure settings. CONCLUSION: Supportive relationships can help nurses to manage emotional stress, and continuing personal and professional development can reduce burnout in qualified nurses in secure settings.

Exploring learning opportunities for nursing students in prison settings.

Custodial environments have traditionally been overlooked as centres of learning for students from all health and social care backgrounds. Recent research has identified many advantages of placements in custodial settings, both in terms of student learning and developing good practice within custodial environments. This article aims to alert nursing students to some of the unique clinical experiences that can be gained within prison healthcare settings.

The Army chemical/biological SMART (SMART-CB) team: the nurse's role.

A chemical or biologic attack probably will be covert, rather than overt. Because presenting signs and symptoms may mimic minor nonspecific illnesses or naturally produced disease syndromes and may not appear for several days, it is likely that nurses in emergency rooms and primary care settings will be among the first to come into contact with victims of a chemical or biologic agent exposure. Early recognition, reporting, decontamination, self-protection, prophylaxis, and treatment are imperative. After the terrorist attack on September 11, 2001, the anthrax incidents, and the heightened publicity of chemical and biologic agent attacks brought on by media coverage, the need for highly trained and well-prepared medical personnel has increased dramatically. Army nurses have led the way in training and expanding the capabilities of specialized medical response teams. Team members require ongoing training, state-of-the-art protective equipment and medical supplies, and constant practice to maintain the high state of readiness required to respond rapidly and effectively to chemical or biologic threats. Army SMART-CB nurses and their team members are well prepared to provide lifesaving care in highly contaminated areas. It is no longer a question of if but rather when and where the next attack will occur.